Provider Demographics
NPI:1467654970
Name:MCELROY, KEVIN C (M-PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:MCELROY
Suffix:
Gender:M
Credentials:M-PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:3344 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-582-7213
Practice Address - Fax:479-521-1843
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT-2857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A387OtherAR BC/BS
AR5A387Medicare PIN
AR5A387B836Medicare PIN
AR5A387C912Medicare PIN
AR5A387B809Medicare PIN
AR5A387F430Medicare PIN
AR5A3876658Medicare PIN
AR5A387F220Medicare PIN
AR5A387OtherAR BC/BS
AR5A387F276Medicare PIN
AR5A387B775Medicare PIN